The report is based on a one-year study on 'Economic Burden of Tobacco Related Diseases in India' conducted by the Public Health Foundation of India with support from the union ministry of health and family welfare, and the World Health Organization.

The amount was the aggregate of four major tobacco-induced ailments in Kerala, contributing to 51 percent of total direct medical costs.

Significantly, the total direct medical costs from tobacco-induced cardiovascular diseases in Kerala is the highest among south Indian states, another recent report said.

The direct medical cost from tobacco-related heart diseases in neighbouring Tamil Nadu is 46 percent, while that in Andhra Pradesh and Karnataka it is respectively 48 and 40 percent.

The study, whose results were released on Monday, estimated the economic costs for people in the age group of 35-69 in 2011.

Direct medical costs include patients' healthcare expenditure in hospitals or visits to outpatient facilities for medicines, diagnostic tests, and surgeon's or medic's fees.

Indirect costs accrue from expenses on transportation, lodging for caregivers and loss of household income due to hospitalisation, besides costs from premature deaths.

The economic burden study has suggested a host of measures to deal with the tobacco menace. These include strengthening the implementation of Indian tobacco control laws and imposing uniform taxes on all tobacco products like cigarettes and bidis.

It has also recommended prohibition of sale and manufacture of all forms of smokeless tobacco products/chewable tobacco, and push for high-visibility public awareness campaigns to consistently reach out to various target audience.